Policy, regulation, and information technology are 3 external levers that have been applied to clinical practice in an effort to create better value in health care. Yet, like clinical interventions, these initiatives may have adverse unintended consequences for patients and their care teams.

In response to these outside forces, the daily work of physicians and their teams has increasingly been oriented around administrative tasks, such as prior authorizations, computerized order entry, billing-related documentation, compliance, and performance measurement. This orientation is associated with costs that only recently have been quantified. For example, administrative tasks associated with reporting performance measures alone are estimated to cost $15.4 billion annually in the United States (1).

Such tasks as documenting pain levels, learning styles, advance directives, or fall risk may each require only a minute or two, so the time costs to an entity imposing such requirements may seem trivial. Multiplied over the hundreds of daily tasks performed by physicians and their staff, however, these costs become substantial. Taking 10 minutes per visit to ask patients mandatory, one-size-fits-all questions directs focus away from activities of greater importance to individual patients. Likewise, 30 minutes spent obtaining a prior authorization for a magnetic resonance imaging scan, ordered by a physician with a track record of appropriate imaging requests, is 30 minutes that physician or staff is unavailable to other patients who need care.

Physicians may now spend more time documenting care and complying with administrative and regulatory requirements than caring for patients. For example, physicians...